title: Inter-rater agreement of the triage system RETTS-HEV.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the inter-rater agreement among nurses using the triage system RETTS-HEV (rapid emergency triage and treatment system - hospital unit west) in a Danish emergency department (ED).
  
  
  BACKGROUND
  The use of triage systems in Denmark has been implemented recently together with structural changes in hospital organization. Testing and evaluation is therefore needed. The RETTS-HEV is a five-scale triage system being used in the ED of Herning, Denmark, since May 2010. The ED is semilarge, with 29 000 annual visits.
  
  
  METHODS
  Consecutive patients presenting to the ED were assessed by both a duty and a study nurse using RETTS-HEV. Nurses did not receive training before the study. In all, 146 patients were enroled and a blinded, paired and simultaneous triage was conducted independently to evaluate inter-rater agreement using Fleiss κ.
  
  
  RESULTS
  A total of 155 patients were triaged over a 10-day period and complete data were available for 146 patients. We found the overall agreement to be good [Fleiss κ 0.60 (95% confidence interval 0.48; 0.72)]. The κ estimate was higher for the group of patients who required immediate attention [0.83 (95% confidence interval 0.18; 1.47)].
  
  
  CONCLUSIONS
  The study found good inter-rater agreement between two independent observers not receiving any new triage training before the study.
authors.affiliation: Departments of aEmergency bOccupational Medicine, Regional Hospital of Herning, Herning cResearch Center for Emergency Medicine, University of Aarhus, Aarhus, Denmark.
authors.forename: Louise
authors.initials: L
authors.lastname: Nissen
authors.forename: Hans
authors.initials: H
authors.lastname: Kirkegaard
authors.forename: Noel
authors.initials: N
authors.lastname: Perez
authors.forename: Ulf
authors.initials: U
authors.lastname: Hørlyk
authors.forename: Louise P
authors.initials: LP
authors.lastname: Larsen
mesh_terms: D000465:Algorithms; D003658:Decision Making, Computer-Assisted; D003718:Denmark; D016529:Emergency Nursing; D004636:Emergency Service, Hospital; D006801:Humans; D007318:Inservice Training; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D015203:Reproducibility of Results; D014218:Triage / Q000379:methods* / Q000458:organization & administration